Five-year results after anti-incontinence operations

OBJECTIVE: This study was undertaken to evaluate continence rates 5 years a fter anterior colporrhaphy, anterior colporrhaphy with needle suspension of the bladder neck, and Burch colposuspension. STUDY DESIGN: Among 544 women with stress incontinence who were operated on between 1989 and 1993, 327 women (60%) underwent clinical and urodynamic r eevaluation 5 years after the operation. Choice of surgical procedure was m ade on the basis of clinical and urodynamic findings and of physician prefe rence. Continence was defined as no loss of urine during cystometry or duri ng coughing with the bladder filled to 300 mL. RESULTS: The 327 patients underwent a total of 334 operations. The objectiv e overall continence rates at 5 years were 61% (65/107) after anterior repa ir, 49% (59/121) after anterior repair with needle suspension, and 79% (84/ 106) after Burch colposuspension. Continence rates after anterior colporrha phy were 82% (32/39) among patients with mild stress incontinence but 49% ( 33/68) among those with moderate or severe incontinence (P < .02). Continen ce rates among patients with moderate or severe incontinence were 49% (59/1 21) after anterior repair with needle suspension and 79% (84/106) after the Burch operation (P < .02). CONCLUSION: Anterior colporrhaphy can cure mild stress incontinence but is inadequate to correct severe incontinence. Additional needle suspension may be of benefit for patients with moderate to severe incontinence. Abdominal colposuspension is superior to the vaginal operations for long-term cure o f stress incontinence.